New Life Safety Code Form

Date:

Provider Name:

Name of Facility:

Address of Facility (including zip code):

Name/Title of Contact Person:

Telephone Number (include area code) of Contact Person:

Survey Questions:

1.  Estimated cost for adding a fire sprinkler system to the attic or cost for adding a heat detection alternative to the attic

$_____________for fire sprinkler system  

or

$_____________for heat detection alternative 

2.  Estimated cost for adding a fire sprinkler system to a roofed porch $__________ N/A

3.  Estimated cost for adding a fire sprinkler system to a roofed deck $__________ N/A

4.  Estimated cost for adding a fire sprinkler system to a roofed balcony $__________ N/A